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Sedative, Hypnotic, or Anxiolytic Use Disorder
DSM-IV In DSM-IV, this is a category called Sedative, Hypnotic, or Anxiolytic Use Disorders Disorders # Sedative, Hypnotic, or Anxiolytic Dependence # Sedative, Hypnotic, or Anxiolytic Abuse DSM-5 Diagnostic Criteria A'''. A problematic pattern of sedative, hypnotic, or anxiolytic use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period: # Sedatives, hypnotics, or anxiolytics is often taken in larger amounts or over a longer period than was intended. # There is a persistent desire or unsuccessful efforts to cut down or control sedative, hypnotic, or anxiolytic use. # A great deal of time is spent in activities necessary to obtain the sedative, hypnotic, or anxiolytic; use the sedative, hypnotic, or anxiolytic; or recover from its effects. # Craving, or a strong desire or urge to use the sedative, hypnotic, or anxiolytic. # Recurrent sedative, hypnotic, or anxiolytic use resulting in a failure to fulfill major role obligations at work, school, or home (e.g., repeated absences from work or poor performance related to sedative, hypnotic, or anxiolytic use; sedative-, hypnotic-, or anxiolytic-related absences, suspensions, or expulsions from school; neglect of children or household). # Continued sedative, hypnotic, or anxiolytic use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of sedatives, hypnotics, or anxiolytics (e.g., arguments with a spouse about consequences of intoxication; physical fights). # Important social, occupational, or recreational activities are given up or reduced because of sedative, hypnotic, or anxiolytic use. # Recurrent sedative, hypnotic, or anxiolytic use in situations in which it is physically hazardous (e.g., driving an automobile or operating a machine when impaired by sedative, hypnotic, or anxiolytic use). # Sedative, hypnotic, or anxiolytic use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the sedative, hypnotic, or anxiolytic. # Tolerance, as defined by either of the following: #* '''a. A need for markedly increased amounts of the sedative, hypnotic, or anxiolytic to achieve intoxication or desired effect. #* b'''. A markedly diminished effect with continued use of the same amount of the sedative, hypnotic, or anxiolytic. #* '''Note: This criterion is not considered to be met for individuals taking sedatives, hypnotics, or anxiolytics under medical supervision. # Withdrawal, as manifested by either of the following: #* a'''. The characteristic withdrawal syndrome for sedatives, hypnotics, or anxiolytics. #* '''b. Sedatives, hypnotics, or anxiolytics (or a closely related substance, such as alcohol) are taken to relieve or avoid withdrawal symptoms. #* Note: This criterion is not considered to be met for individuals taking sedatives, hypnotics, or anxiolytics under medical supervision. Specify if: * In early remission: After full criteria for sedative, hypnotic, or anxiolytic use disorder were previously met, none of the criteria for sedative, hypnotic, or anxiolytic use disorder have been met for at least 3 months but for less than 12 months (with the exception that Criterion A4, "Craving, or a strong desire or urge to use the sedative, hypnotic, or anxiolytic," may be met). * In sustained remission: After full criteria for sedative, hypnotic, or anxiolytic use disorder were previously met, none of the criteria for sedative, hypnotic, or anxiolytic use disorder have been met at any time during a period of 12 months or longer (with the exception that Criterion A4, "Craving, or a strong desire or urge to use the sedative, hypnotic, or anxiolytic," may be met). Specify if: * In a controlled environment: This additional specifier is used if the individual is in an environment where access to sedatives, hypnotics, or anxiolytics is restricted. Note: If a sedative, hypnotic, or anxiolytic intoxication; sedative, hypnotic, or anxiolytic withdrawal; or another sedative-, hypnotic-, or anxiolytic-induced mental disorder is also present, the comorbid sedative, hypnotic, or anxiolytic use disorder is indicated in the sedative-, hypnotic-, or anxiolytic-induced disorder. For example, if there is comorbid sedative, hypnotic, or anxiolytic-induced depressive disorder and sedative, hypnotic, or anxiolytic use disorder, only the sedative-, hypnotic-, or anxiolytic-induced depressive disorder diagnosis is given, with the recording indicating whether the comorbid sedative, hypnotic, or anxiolytic use disorder is mild, moderate, or severe (e.g., mild sedative, hypnotic, or anxiolytic use disorder with sedative-, hypnotic-, or anxiolytic-induced depressive disorder; moderate or severe sedative, hypnotic, or anxiolytic use disorder with sedative-, hypnotic-, or anxiolytic-induced depressive disorder). Specify current severity: * Mild: Presence of 2-3 symptoms. * Moderate: Presence of 4-5 symptoms. * Severe: Presence of 6 or more symptoms. Specifiers "In a controlled environment" applies as a further specifier of remission if the individual is both in remission and in a controlled environment (i.e., in early remission in a controlled environment or in sustained remission in a controlled environment). Examples of these environments are closely supervised and substance-free jails, therapeutic communities, and locked hospital units. Differential Diagnosis Other mental disorders or medical conditions Individuals with sedative-, hypnotic-, or anxiolytic-induced disorders may present with symptoms (e.g., anxiety) that resemble primary mental disorders (e.g., generalized anxiety disorder vs. sedative-, hypnotic-, or anxiolytic-induced anxiety disorder, with onset during withdrawal). The slurred speech, incoordination, and other associated features characteristic of sedative, hypnotic, or anxiolytic intoxication could be the result of another medical condition (e.g., multiple sclerosis) or of a prior head trauma (e.g., a subdural hematoma). Alcohol use disorder Sedative, hypnotic, or anxiolytic use disorder must be differentiated from alcohol use disorder Clinically appropriate use of sedative, hypnotic, or anxiolytic medications Individuals may continue to take benzodiazepine medication according to a physician's direction for a legitimate medical indication over extended periods of time. Even if physiological signs of tolerance or withdrawal are manifested, many of these individuals do not develop symptoms that meet the criteria for sedative, hypnotic, or anxiolytic use disorder because they are not preoccupied with obtaining the substance and its use does not interfere with their performance of usual social or occupational roles.